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MENINGOCOCCAL MENINGITIS VACCINE

What is meningococcal disease?

Meningococcal disease is a potentially life-threatening bacterial infection. The disease most commonly is expressed as either meningococcal meningitis, an inflammation of the membranes surrounding the brain and spinal cord, or meningococcemia, a presence of bacteria in the blood. Meningococcal disease is caused by Neisseria meningitis, which has become the leading cause of bacterial meningitis in older children and young adults in the United States. Meningococcal disease strikes about 3,000 Americans each year, leading to death in approximately 10-15 percent of cases, which translates into 300 deaths annually. It is estimated that 100 to 125 cases of meningococcal disease occur annually on college campuses and five to 15 students die each year as a result. The disease can result in permanent brain damage, hearing loss, learning disability, amputation, kidney failure, or death.

There are five strains or serogroups of N. meningitis that cause meningococcal disease. These are A, B, C, Y, and W-135. Among the serogroups responsible for invasive meningococcal disease in the United States in 1997, serogroup C caused about 28 percent of cases, serogroup B about 30 percent, serogroup Y about 37 percent, and serogroups A and W-135 were extremely rare. Serogroup A is predominantly a cause of meningococcal disease in Africa and Asia.

In the United States, the incidence of meningitis outbreaks of serogroup C has risen sharply in the past 10 years, especially among young adults in school and community settings. There were 26 outbreaks between 1994 and 1996, four of these outbreaks at a college or university, compared with only 15 outbreaks occurring between 1989 to 1993, including two outbreaks at a college or university.

What are the symptoms of meningococcal disease?

Meningococcal disease usually peaks in late winter and early spring. The disease can easily be misdiagnosed as something less serious, because symptoms are similar to the flu. The most common symptoms include high fever, headaches, neck stiffness, confusion, nausea, vomiting, lethargy, and/or rashes. Anyone with similar symptoms should contact a physician immediately. If not treated the disease can progress rapidly and can lead to shock and death, often within hours of the onset of symptoms.

Who is at risk for meningococcal disease?

Meningococcal disease can affect people at any age. Certain groups seem to be at increased risk of contracting the disease including those in close contact with a known case, patients with compromised immunity, and persons traveling to specific endemic areas of Asia, Africa, or South America.

Since 1991, cases of meningococcal disease among 15-24 year olds have more than doubled. Recent evidence found students residing on campus in dormitories appear to be at higher risk for meningococcal disease. The highest risk appeared to be in freshmen living in dormitories, who seemed to have a six times higher risk than college students overall. Data also suggests that certain social behaviors such as exposure to passive and active smoking, bar patronage, and excessive alcohol consumption may increase students' risk for contracting the disease.

Is there a meningococcal vaccine?

The vaccine called "Menomune" is available against four of the most common strains of N. meningitidis in the United States (A, C, Y, W-135) and can be used in adults and children greater than two years old. The vaccine is between 85 to 100 percent effective in preventing meningococcal disease. A single-dose vaccination produces protective antibody levels in 10 to 14 days. The vaccine does not currently provide any protection against the B strain or serotype.

Based on the possibility of increased risk of this disease among segments of the college population, the American College Health Association (ACHA) recommends that students consider vaccination to reduce their risk for potentially fatal meningococcal disease. Recently, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has decided to support ACHA's decision to educate students and parents about meningococcal disease and the availability of a safe and effective vaccine to help prevent it. ACHA and the CDC are collaborating on surveillance studies to further assess the risk of meningococcal disease in the college population. Their current recommendation reads:

• "Vaccination should be provided or made easily available to those freshmen who wish to reduce their risk of disease. Other undergraduate students wishing to reduce their risk of meningococcal disease can also choose to be vaccinated."

Who should not get the vaccine?

You Should not receive the Menomune meningococcal vaccine if:

• you are pregnant or suspect that you might be pregnant
• you are allergic to thimerosal, a substance found in several vaccines and in several contact lens solution
• you have an acute illness, with fever (101F or higher).

What are the possible side effects of the vaccine?

The vaccine is considered relatively free of side effects and is generally effective for three-five years. Minor reactions may include redness and swelling at the injection site that may last one to two days. About 2 percent of recipients may develop fever after vaccination. If you develop a high or persistent fever, consult a physician. Extremely rare allergic reactions have occurred, including those resulting in hives, asthma, and even anaphylaxis. As with any vaccine, vaccination with meningitis vaccine does not protect 100 percent of all susceptible individuals.

How is meningococcal disease transmitted?

Meningococcal bacteria are transmitted through the air via droplets of respiratory secretions and direct contact with persons infected with the disease. Oral contact with shared items such as cigarettes or drinking glasses or through intimate contact such as kissing could put a person at risk for acquiring the infection.

Approximately 10 percent of the general population may carry meningococcal bacteria in their nose and throat in a harmless state. This carrier state may last for days or months before spontaneously disappearing, and it seems to give persons who harbor the bacteria in their upper respiratory tracts some protection from developing meningococcal disease.

During meningococcal disease outbreaks, the percentage of people carrying the bacterium may approach 95 percent, yet the percentage of people who develop meningococcal disease is less than 1 percent. This low occurrence of disease following exposure suggests that a person's own immune system, in addition to bacterial factors, plays a key role in disease development.

Meningococcal bacteria cannot usually live for more than a few minutes outside the body. As a result, they are not easily transmitted in water supplies, swimming pools, or by routine contact with an infected person in a classroom, dining room, bar, restroom, etc.

Roommates, friends, spouses, and children who have had intimate contact with the oral secretions of a person diagnosed with meningococcal disease are at risk for contracting the disease and should receive prophylactic medication immediately. Examples of such contact include kissing, sharing eating utensils, and being exposed to droplet contamination from the nose or throat.

What is the treatment for meningococcal disease exposure?

Treatment of infected persons

Meningococcal disease can be rapidly progressive. With early diagnosis and treatment, however, the likelihood of recovery is increased.

Early recognition, performance of a spinal tap, and prompt initiation of antibiotic therapy are crucial.

Chemoprophylaxis

The use of such prophylactic antibiotics as ciprofloxacin or rifampin is recommended for those who may have been exposed to a person diagnosed with meningococcal disease. Anyone who suspects exposure should consult a physician immediately. Prophylactic antibiotics may also be prescribed for asymptomatic meningococcus carriers.

Vaccination

As an adjunct to appropriate antibiotic chemoprophylaxis, immunization against the meningococcal bacterium may be recommended when an outbreak of meningococcal disease has occurred in a community. It is important to note that meningococcal vaccine should not be used in place of chemoprophylaxis for those exposed to an infected person; protection from immunization is too slowly generated in this situation.

How can one reduce the risk of contracting meningococcal disease?

Maximize your body's own immune system response. A lifestyle that includes a balanced diet, adequate sleep, appropriate exercise, and the avoidance of excessive stress is very important. Avoiding upper respiratory tract infections and inhalation of cigarette smoke may help to protect from invasive disease. Everyone should be sensitive to public health measures that decrease exposure to oral secretions, such as covering one's mouth when coughing or sneezing and washing hands after contact with oral secretions.

Meningitis Vaccination (Menomune) at Luther College

Luther College Health Service makes available the meningitis vaccine (Menomune) to interested students. The cost to registered students is currently $74.00. The vaccine needs to be readministered every 3-5 years to maintain protection.

Luther College Health Service currently neither recommends nor discourages students from considering this vaccination. While the incidence of meningitis in close-contact populations in the U.S. - such as new military recruits, students in residence halls, and others - sometimes may be higher than the general public, the actual rates in this country remain quite low.

According to the U.S. Centers for Disease Control and Prevention(CDC) in a study of meningococcal disease in college students:

• Between September 1998 and June 1999, a total of 88 cases of meningococcal disease in college students were detected.
• Six students died and at least four of these deaths may have been preventable by the currently available meningococcal vaccine.
• CDC states (as of 9/21/99) "Overall, college students do not seem to be at higher risk for meningococcal disease, and in fact have lower rates of disease than the general population of 18-24 year olds. Freshmen, particularly those who live in dormitories, constitute a group at modestly increased risk of meningococcal disease relative to other persons their age. Immunization with the currently available meningococcal vaccine will decrease the risk for meningococcal disease in individuals who choose to be vaccinated."

Meningitis can be a catastrophic and even lethal disease if acquired. The vaccination itself carries some risk of side effects and is not 100% effective. All of these factors must be weighed by students when making their vaccination decisions.

Luther College Health Service clinical staff will be happy to discuss each student's own health needs, risks and other issues through an appointment for that purpose. If you have unique health needs or specific concerns about your risk for this disease, you may make an appointment with a physician or nurse practitioner.
To make an appointment, call the appointment desk at 387-1045.

Other sites with information on meningococcal disease:

• American College Health Association - includes news releases, overview, and FAQs.
• "The Changing Epidemiology of Meningococcal Disease in the US . . ." - from the National Foundation for Infectious Diseases.
• "Risk of Meningococcal Infection in College Students" - from the Journal of the American Medical Association, May 26, 1999.
• "The Unknown Killer: What Is Meningitis, and Who’s at Risk" - from ABC News 20/20 show televised on September 17, 1999.
• "Meningococcal Disease among College Students" - 10/20/99 statement from the Advisory Committee on Immunization Practices (ACIP).
• Centers for Disease Control and Prevention (CDC) - Meningococcal Disease